Provider Demographics
NPI:1477709244
Name:BOCA RATON REGIONAL HOSPITAL
Entity type:Organization
Organization Name:BOCA RATON REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-955-5484
Mailing Address - Street 1:P.O. BOX 105046
Mailing Address - Street 2:MAIL CODE 5598
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30348-5046
Mailing Address - Country:US
Mailing Address - Phone:561-955-4797
Mailing Address - Fax:561-955-4723
Practice Address - Street 1:690 MEADOWS ROAD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2344
Practice Address - Country:US
Practice Address - Phone:561-955-3772
Practice Address - Fax:561-955-4444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOCA RATON REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-13
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54973207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty